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General NPI Number Information
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NPI Number | 1053583682
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Entity Type | Organization
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Legal Business Name | ORG MEDICAL PLLC
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 99 MOORE ST UNIT 1- Z
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City | BROOKLYN
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State | NY
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Zip | 11206-3302
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Country | US
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Telephone | 917-538-9844
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Fax |
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Provider Business Mailing Address
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Address Line | 99 MOORE ST UNIT 1- Z
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City | BROOKLYN
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State | NY
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Zip | 11206-3302
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Country | US
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Telephone | 917-538-9844
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MRS. OLGA TYULENEVA
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Credential | M.D.
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Telephone | 917-538-9844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 9K5581
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License Number State | NY
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